Employers who offer group health plans must comply with a range of federal and state regulations. These requirements protect employees, ensure transparency, and help avoid costly penalties. Use these FAQs to get a quick overview of each rule, what’s required, and when notices or filings are due.
Compliance Topics
Marketplace Notice (Notice of Coverage Options)
All employers subject to the Fair Labor Standards Act (FLSA) must provide a Notice of Coverage Options to new hires. These FAQs explain who must provide it, when it’s due, and what it needs to include.
HIPAA Notice
HIPAA requires employers to provide a notice of special enrollment rights and, if applicable, a Notice of Privacy Practices. These FAQs clarify what notices are required and when.
COBRA
COBRA requires employers with 20 or more employees to offer continuation coverage to employees and dependents who lose coverage due to certain qualifying events. These FAQs cover COBRA eligibility, notice timing, and what benefits must be continued.
State Continuation
For small employers not subject to COBRA—or as an extension after COBRA—many states have continuation laws for fully insured medical plans. Explore these FAQs for rules in Texas and other key states.
Summary of Benefits and Coverage (SBCs)
The SBC is a standardized document that helps employees compare health plans. These FAQs explain who must distribute it, when it’s required, and what must be included.
ERISA (SPDs, Wrap Documents, and more)
ERISA requires employers to provide a Summary Plan Description (SPD) for each group health plan. These FAQs explain SPD requirements, how wrap documents work, and what to include in ERISA disclosures.
Medicare Part D Notice
Employers offering prescription drug coverage must notify Medicare-eligible individuals whether the coverage is creditable. These FAQs cover what the notice must say, who must get it, and when it must be provided—to both individuals and CMS.
Medicare Secondary Payer (MSP)
Employers with group health plans must coordinate properly with Medicare. These FAQs explain when your plan must pay primary, what reporting is required, and how to avoid compliance errors.
RxDC Reporting
Under the No Surprises Act, health plans must report prescription drug and health care spending data annually. These FAQs outline who is responsible, what’s reported, and when it’s due.
ACA Employer Reporting (Forms 1094/1095)
Applicable Large Employers (ALEs) and self-funded groups must report health coverage to the IRS and to individuals under Sections 6055 and 6056. These FAQs cover which forms to file, who must file them, and key deadlines.